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Evidence-informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource-constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation, and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking, particularly for some of its high-priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence-informed decision making, demonstrating the continued evolution of India’s evidence policy system.

Background Idiopathic pulmonary fibrosis (IPF) is one of the common types of interstitial lung disease having high prevalence and mortality worldwide. As a result of patient-centred hindering factors of adherence to centre-based pulmonary rehabilitation (PR), home-based PR is an alternate mode of rehabilitating individuals with IPF. This systematic review will evaluate the effectiveness of unsupervised home-based PR on functional capacity and health-related quality of life (HRQoL) in individuals with IPF. Methods Clinically stable, high resolution computed tomography and physician diagnosed IPF participants having modified Medical Research Council score below 5 will be considered for the systematic review. Studies involving home-based PR as an intervention to treat individuals with IPF will be considered. Randomised controlled trials and quasi-randomised studies (with two groups followed up) are eligible to be included. Outcomes of our interest are functional capacity (6-min walk distance, shuttle walk test and incremental shuttle walk test) and secondary outcome measure would include assessment of quality of life and adverse effects of intervention. Electronic databases such as SCOPUS, Medline (PubMed and Web of Science), PEDRo and CINAHL will be searched using database specific terms. Additionally, forward and backward citations of included studies will be searched to identify potential records. Two review authors, independently, will conduct the screening, data extraction using a customised standard tool, and critical appraisal using Cochrane Risk of Bias 2 tool of included studies. If data permits, meta-analysis will be conducted. In case of substantial heterogeneity, we will do a narrative synthesis. Subgroup analysis will be undertaken based on various contextual and interventional factors. Discussion This review will provide comprehensive evidence on the effectiveness of unsupervised home-based PR to physiotherapists, policy makers and researchers who are interested in IPF management. Findings from this review may guide the development and evaluation of more robust evidence based home-based PR that aimed to improve functional capacity among people with IPF. Systematic review registration PROSPERO CRD42020213883.

ObjectiveTo support evidence-informed decision-making, we created an evidence gap map to characterise the evidence base on the effectiveness of interventions in improving routine childhood immunisation outcomes in low-income and middle-income countries (LMICs).MethodsWe developed an intervention–outcome matrix with 38 interventions and 43 outcomes. We searched academic databases and grey literature sources for relevant impact evaluations (IEs) and systematic reviews (SRs). Search results were screened on title/abstract. Those included on title/abstract were retrieved for full review. Studies meeting the eligibility criteria were included and data were extracted for each included study. All screening and data extraction was done by two independent reviewers. We analysed these data to identify trends in the geographic distribution of evidence, the concentration of evidence across intervention and outcome categories, and attention to vulnerable populations in the literature.ResultsWe identified 309 studies, comprising 226 completed IEs, 58 completed SRs, 24 ongoing IEs and 1 ongoing SR. Evidence from IEs is heavily concentrated in a handful of countries in sub-Saharan Africa and South Asia. Among interventions, the most frequently evaluated are those related to education and material incentives for caregivers or health workers. There are gaps in the study of non-material incentives and outreach to vulnerable populations. Among outcomes, those related to vaccine coverage and health are well covered. However, evidence on intermediate outcomes related to health system capacity or barriers faced by caregivers is much more limited.ConclusionsThere is valuable evidence available to decision-makers for use in identifying and deploying effective strategies to increase routine immunisation in LMICs. However, additional research is needed to address gaps in the evidence base.

Introduction: The World Health Organization recommends exclusive breastfeeding for every newborn during the first 6 months of life, yet women come across various challenges to continuing it. Aim: This systematic review was intended to identify barriers to exclusive breastfeeding among mothers. Methods: MEDLINE, Cumulative Index to Nursing and Allied health literature, ProQuest, Web of Science and Scopus databases were searched from January 1990 to October 2017. The systematic review included quantitative, qualitative and mixed-methods studies to identify barriers to exclusive breastfeeding among mothers of reproductive age with an infant aged between 0 and 12 months. All studies were screened based on titles, abstracts and full text by two reviewers independently. The methodological quality of included studies was assessed using appropriate tools. Of the 9737 eligible records, 44 studies were included for analysis. Classification of barriers to exclusive breastfeeding was adopted from the conceptual framework of factors affecting breastfeeding practices given by Hector and colleagues. Results: In total 32 barriers were grouped under individual, group and society level factors. Meta-analysis indicated that mothers who smoked had 2.49 times more odds of not exclusively breastfeeding than non-smoking mothers and mothers who had undergone caesarean section had 1.69 times more risk of cessation of exclusive breastfeeding than mothers who have had a vaginal childbirth. Conclusion: The systematic review revealed a complex interplay of various barriers related to exclusive breastfeeding. It is recommended that context-specific strategies should be designed in accordance with barriers existing in a region or country.

Aim The review was conducted to collate the evidence on the current status of "Reproductive, Maternal, Newborn, Child and Adolescent Health" (RMNCAH) and related Behaviour Change Communication (BCC) interventions in RMNCAH in South Asia, particularly Bangladesh, Nepal and India. Methods Literature search was conducted on multiple databases and websites in March 2019. The search was limited to English language publications. The data on health indicators for the eight South Asian countries are compared in the review. This review narratively summarises the key RMNCAH and related BCC initiatives undertaken in Bangladesh, Nepal and India. Results The South Asian countries have achieved significant progress in socio-economic indicators related to health aligned with the Millennium Development Goals but face a number of challenges. There has been a significant development in financial incentives, programmes and policies framed for improving indicators of maternal and child health. Various RMNCAH initiatives which impact positively on maternal and child health indicators were identified. Conclusion Bangladesh, Nepal and India have made substantial improvement in maternal and child health indicators but at a slower pace than other countries of South Asia, in relation to which consistent disparities still exist. There are a number of BCC initiatives targeting RMNCAH. The improvement in RMNCAH indicators can be attributed to multiple initiatives wherein the contribution of BCC is relevant, because of their wide community outreach and effectiveness among all age-groups.

Background The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by patients’ cultural beliefs and social systems. This scoping review aims to summarise concerns and coping mechanisms of women with breast cancer in Asia and understand gaps in the existing literature. Methods We performed a scoping review using the population-concept-context strategy. A systematic search of Medline (PubMed, Web of Science), CINAHL, SCOPUS, and Embase was conducted for studies on breast cancer patients from Asian countries, identifying their concerns and coping means, published between January 2011 and January 2021. Data from included studies was reported using frequencies and percentages. Results We included 163 articles for review. Most (81%) studies were conducted in hospital settings. Emotional and psychological concerns were reported by 80% of studies, followed by physical appearance and body-image concerns in 46%. Social support (59%), emotion-based coping (46%), spirituality and problem-based coping (37%) were the major coping systems documented. Conclusion The mapped literature documented that anxiety, depression, and fear of cancer recurrence dominated women’s emotional concerns. Women coped with the help of social support, positive reappraisal, and faith in God and religion. Sensitization of caregivers, including healthcare professionals and family members, to context-specific concerns and inquiry into the patients’ available support systems is essential in strengthening the breast cancer women’s recovery and coping.

IntroductionForward head posture (FHP) is the most common postural deviation of the upper back. It is believed to be one of the predisposing factors for the development of mechanical neck pain (MNP). We propose doing a systematic review to find the effectiveness of interventions targeted on FHP with MNP and assess implementation fidelity associated with these interventions.Methods and analysisMedline (PubMed), Web of Science (Social Science Citation Index), EMBASE, Scopus, PEDro and CINAHL databases will be searched for studies published in English from their inception. Forward and backward citations of the included studies will be investigated for identifying additional records. We will include randomised controlled trials and non/quasi-experimental studies with two groups assessing the effectiveness of interventions targeted on FHP with MNP. Observational studies, non-randomised studies with single group and reviews will be excluded. We will consider the following outcome measures: postural variables of FHP, neck pain, performance-based functional disability scores of the neck, quality of life, basic activities of daily living and work-related outcomes. The unique citations will be screened by titles/abstracts and full texts, independently. The Cochrane Risk of Bias 2 tool will be used to critically appraise the included studies. The risk of bias and data abstraction of included studies will be undertaken independently. A qualitative synthesis will be conducted and, if sufficient studies with comparable outcome measures are available, we will statistically pool the result.Ethics and disseminationWe will undertake a systematic review of primary studies, and will not directly recruit participants hence, ethical clearance is not applicable. We will aim to present the findings of the completed systematic review at an international conference and subsequently submit the manuscript in a peer-reviewed journal for publication.PROSPERO registration numberCRD42021250310.

Health Technology Assessment (HTA) is a multifaceted approach for informing policy by considering social, medical, economic and ethical aspects in a systematic and transparent manner. HTA is an important tool for decision-making, priority-setting and for resource allocation, leading to Universal Health Coverage (UHC). The importance of HTA becomes more pronounced in developing countries such as India. In this review, we have summarised the status and future scope of HTA in India after referring to the scientific literature available in the form of journal articles and government reports. HTA supports prioritisation of healthcare services to be included in UHC and the provision of affordable and quality healthcare services in India. India established ‘HTA in India’ (HTAIn) in January 2017 as a starting point in HTA activities and this centre conducts HTA studies of various methodologies upon receiving requests from the different central and state departments. HTA in India is a relatively new concept and the processes are not streamlined compared to countries where HTA is established. Although an HTA manual is present for guiding the HTA process in India, there is lack of clarity on the HTA information considered for translating evidence into policy or practice. Additionally, there is a dearth of individual capacity to undertake high quality HTA in the country. HTAIn initiative showcases India’s political commitment towards achieving UHC and for HTA. However, there is an imminent need to expand the role of the technical partners and regional resource hubs in capacity building in HTA by involving the private sector in HTA processes.

Background: This review aims to map the evidence on the effectiveness of Complementary and Alternative Medicine (CAM) for Type 2 Diabetes Mellitus (T2DM) and its associated complications and identify research gaps in key outcomes and CAMs. Methods: We followed the Johanna Briggs Institute guidelines to undertake this scoping review. We carried out a comprehensive search from inception to March 2020 in electronic databases and registers. Forward and backward citations of included studies were also searched. The randomized controlled trials (RCTs) and non-randomized studies with intervention and control arm were mapped based on the effectiveness of various CAM (Yoga, Ayurveda, Homeopathy, Siddha, Naturopathy, Unani, and Sowa-rigpa) on outcomes among individuals with prediabetes or metabolic syndrome, T2DM with and without any comorbidities. Results: A total of 249 studies were included after screening 3798 citations. Most of the included studies were conducted in India and Iran. Most frequently studied CAM interventions include Yoga, Ayurveda, and herbal products as compared to other CAM therapies. Conclusion: Although we identified a lot of literature on the effectiveness of CAMs for T2DM, there is a lack of standardization of preparation of these medicines and the interventional modalities. To validate the potential benefits of CAM, robust research with high-quality RCTs and systematic reviews are needed to bridge the gap of evidence in CAM therapies. Future investments for research in CAM may focus on assessing the quality of existing trials and finding out an optimal dose, frequency, and duration of CAM, both as an alternative and complementary approach.

ObjectiveUniversal Health Coverage aims to address the challenges posed by healthcare inequalities and inequities by increasing the accessibility and affordability of healthcare for the entire population. This review provides information related to impact of public-funded health insurance (PFHI) on financial risk protection and utilisation of healthcare.DesignSystematic review.Data sourcesMedline (via PubMed, Web of Science), Scopus, Social Science Research Network and 3ie impact evaluation repository were searched from their inception until 15 July 2020, for English-language publications.Eligibility criteriaStudies giving information about the different PFHI in India, irrespective of population groups (above 18 years), were included. Cross-sectional studies with comparison, impact evaluations, difference-in-difference design based on before and after implementation of the scheme, pre–post, experimental trials and quasi-randomised trials were eligible for inclusion.Data extraction and synthesisData extraction was performed by three reviewers independently. Due to heterogeneity in population and study design, statistical pooling was not possible; therefore, narrative synthesis was performed.OutcomesUtilisation of healthcare, willingness-to-pay (WTP), out-of-pocket expenditure (including outpatient and inpatient), catastrophic health expenditure and impoverishment.ResultsThe impact of PFHI on financial risk protection reports no conclusive evidence to suggest that the schemes had any impact on financial protection. The impact of PFHIs such as Rashtriya Swasthy Bima Yojana, Vajpayee Arogyashree and Pradhan Mantri Jan Arogya Yojana showed increased access and utilisation of healthcare services. There is a lack of evidence to conclude on WTP an additional amount to the existing monthly financial contribution.ConclusionDifferent central and state PFHIs increased the utilisation of healthcare services by the beneficiaries, but there was no conclusive evidence for reduction in financial risk protection of the beneficiaries.RegistrationNot registered.

BACKGROUND Although well recognized for its scientific value, data sharing from clinical trials remains limited. Steps toward harmonization and standardization are increasing in various pockets of the global scientific community. This issue has gained salience during the COVID-19 pandemic. Even for agencies willing to share data, data exclusivity practices complicate matters; strict regulations by funders affect this even further. Finally, many low- and middle-income countries (LMICs) have weaker institutional mechanisms. This complex of factors hampers research and rapid response during public health emergencies. This drew our attention to the need for a review of the regulatory landscape governing clinical trial data sharing. OBJECTIVE This review seeks to identify regulatory frameworks and policies that govern clinical trial data sharing and explore key elements of data-sharing mechanisms as outlined in existing regulatory documents. Following from, and based on, this empirical analysis of gaps in existing policy frameworks, we aimed to suggest focal areas for policy interventions on a systematic basis to facilitate clinical trial data sharing. METHODS We followed the JBI scoping review approach. Our review covered electronic databases and relevant gray literature through a targeted web search. We included records (all publication types, except for conference abstracts) available in English that describe clinical trial data–sharing policies, guidelines, or standard operating procedures. Data extraction was performed independently by 2 authors, and findings were summarized using a narrative synthesis approach. RESULTS We identified 4 articles and 13 policy documents; none originated from LMICs. Most (11/17, 65%) of the clinical trial agencies mandated a data-sharing agreement; 47% (8/17) of these policies required informed consent by trial participants; and 71% (12/17) outlined requirements for a data-sharing proposal review committee. Data-sharing policies have, a priori, milestone-based timelines when clinical trial data can be shared. We classify clinical trial agencies as following either controlled- or open-access data-sharing models. Incentives to promote data sharing and distinctions between mandated requirements and supportive requirements for informed consent during the data-sharing process remain gray areas, needing explication. To augment participant privacy and confidentiality, a neutral institutional mechanism to oversee dissemination of information from the appropriate data sets and more policy interventions led by LMICs to facilitate data sharing are strongly recommended. CONCLUSIONS Our review outlines the immediate need for developing a pragmatic data-sharing mechanism that aims to improve research and innovations as well as facilitate cross-border collaborations. Although a one-policy-fits-all approach would not account for regional and subnational legislation, we suggest that a focus on key elements of data-sharing mechanisms can be used to inform the development of flexible yet comprehensive data-sharing policies so that institutional mechanisms rather than disparate efforts guide data generation, which is the foundation of all scientific endeavor.

Introduction Collusion and concealing cancer diagnosis is often practiced in India. To get more insights on the perception and practice of disclosing cancer diagnosis, a qualitative study was conducted in south India. Methods In-depth interviews were conducted separately among women diagnosed with breast cancer and their caregivers. Prior permissions from hospital administration and ethical clearance was obtained. Using purposive sampling, 39 caregivers and 35 women diagnosed with breast cancer were recruited from tertiary care hospital. Results Families practiced collusion so as to protect the patient from emotional consequence viz. shock, fear of death and uncertainty about prognosis and treatment. This practice was more common among families who had patient with advanced stage of illness and/or 49 years of age and above. Collusion was mostly seen among Participants concealed the cancer diagnosis from social contacts such as extended family, friends and neighbor. Resultant codes pertaining to nondisclosure were; ‘too many questions’, ‘avoid courtesy visits’, ‘negative suggestions’, ‘perceived stigma’, ‘obstacle in child’s marriage’, and ‘shock’. Conclusions Disclosing cancer diagnosis is considered as ‘bad news’ however, withholding information about health status of patient is not ethically appropriate. Additionally, nondisclosure resulted in diminished support from social contacts. Concordance between cancer diagnosis and patients’ ability to deal with the information is important. Key messages Although nondisclosure of cancer diagnosis and prognosis violates patient autonomy, it was perceived to be beneficial for the patient. A pragmatic disclosure strategy complemented with tailored counselling would be a feasible paradigm.

Background This systematic review and meta-synthesis was conducted to explore the views and experiences of women on family planning in India. Methods We included qualitative studies conducted in India and published in English. PubMed, SCOPUS, Web of Science, CINHAL and ProQuest were searched from inception till April 2019. Population of interest were women in reproductive age group. Additionally, husband of the woman and mother-in-law were eligible to be included. Studies conducted among HIV positive, commercial sex workers and drug addicts were excluded. Selection of studies (titles, abstracts and full tests screening), data extraction and methodological quality assessment (using CASP checklist) was undertaken independently by four authors in pairs. Any discrepancies were resolved by discussion until consensus. Thematic analysis was used to analyse the data (PROSPERO registration number CRD42018093960). Results We included 39 full texts through database and reference searching. Most of the women were married. Main themes were; ‘family influence’, ‘perceived benefits/harm of son/daughter’, ‘perceived misconception of contraception’, ‘socio-cultural norms’, ‘abortion as a family planning option’, ‘healthcare reach and mistrust’ and ‘demographic dividend’. Conclusion There is a need to include husband and mother-in-law while delivering messages or strategies to women on family planning in India. Traditional norms are deep rooted in the community therefore, family planning strategies should be context and need based. Key message Meta-synthesis is a promising approach to gather evidence of complex health problems that require an understanding of social and cultural determinants of health.

IntroductionSouth Asian countries are ageing and experiencing a rapid increase in proportion of the older population. Income support programmes are of central importance for the older adults as they may help to mitigate the poverty risks associated with ageing and losing the ability to generate income from labour. Evidence related to the income support programmes can help in understanding whether the programmes have been impactful. This scoping review will map the evidence (and gaps) related to income support programmes and create a base to identify the feasibility of future primary research and/or the scope of systematic reviews in the areas where evidence is available.Methods and analysisThe Joanna Briggs Institute scoping review methodology will be followed. Eligibility criteria for the scoping review will be based on the ‘PCC’ or the ‘Population–Concept–Context’ concept. Advanced search for the relevant articles will be conducted in MEDLINE (via PubMed), Embase, Scopus, Campbell Collaboration, 3ie International Initiative for Impact Evaluation and Web of Science. Additional resources search will be conducted in important organisational websites. Findings of the scoping review will be summarised using descriptive information (frequencies and percentages) for the available evidence on concept (ie, income support programmes), population characteristics and other study variables.Ethics and disseminationThe review is based on data from available literature, hence an ethical approval is not necessary. With this review, we attempt to provide recommendations to the research community and the policymakers about the currently available evidence and the research required for income support of older adults in South Asia, so that resources can be directed towards addressing the same. We plan to disseminate the findings through presentation in international conference and publication in a peer-reviewed journal.Review registrationNot registered.

Background Globally, very preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born very preterm, family-centered care (FCC) might promote developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on the motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect infant development. Methods Systematic review will be carried out by including (a) quasi-randomized controlled trials and randomized controlled trials (b) of very preterm born infants (born < 32 weeks of gestation), and their primary caregivers will be included in the review (c) who received FCC-based interventions such as collaborative interaction between a healthcare professional and a parent, home program, home visits, and parent education, and (d) measure motor and neurobehavioral function. Electronic databases such as Scopus, PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database-specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, a meta-analysis will be undertaken to assess the effect of the FCC on the motor and neurobehavior of premature infants. Conclusion The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings. Systematic review registration Protocol has been registered in PROSPERO on August 26, 2020.

Additional file 2: Supplementary data file 2. Proposed screening protocol for abstracts and full texts.

Additional file 1: Supplementary data file 1. PRISMA-P checklist.

The global coronavirus disease (COVID-19) pandemic has greatly affected the lives of people living with non-communicable diseases (PLWNCDs). The health of PLWNCDs worsens when synergistic epidemics or "syndemics" occur due to the interaction between socioecological and biological factors, resulting in adverse outcomes. These interactions can affect the physical, emotional, and social well-being of PLWNCDs. In this paper, we discuss the effects of the COVID-19 syndemic on PLWNCDs, particularly how it has exposed them to NCD risk factors and disrupted essential public health services. We conclude by reflecting on strategies and policies that deal with the COVID-19 syndemic among PLWNCDs in low- and middle-income countries.

Background: Globally, preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born preterm, FCC promotes developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect the infant development.Methods: Systematic review will be carried out by including quasi-experimental controlled trials and randomized controlled trials. Electronic databases such as Scopus, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, meta-analysis will be undertaken to assess the effect of FCC on motor and neurobehavior of premature infants.Conclusion: The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings.Systematic review registration: Protocol has been submitted to PROSPERO on July 26, 2020.

Background Micronutrient deficiency affects the health and development of vulnerable population such as children and pregnant women. Measures such as fortification of food and supplementation have been implemented to prevent or control deficiencies related to micronutrients. Objective To assess the effect of vitamin A, vitamin D, and calcium fortification and supplementation on nutritional status of women in reproductive age group. To assess the toxicities and adverse events related to intervention. Methodology Systematic reviews including RCTs on women of reproductive age group provided with vitamin A, vitamin D, and calcium supplementation or fortified food were included, to report all malnutrition-related outcomes due to deficiency of the abovementioned micronutrients. The Cochrane Database of Systematic Reviews, EPPI Centre, Campbell Collaboration, PubMed, Web of Science, and Scopus were searched electronically for English language publications, until 31 March 2018. Hand searching of the articles was done from the Journal of Food Science and Technology. Two independent reviewers selected the systematic reviews, extracted data, and assessed for the quality. Results A total of 16 systematic reviews were included in narrative synthesis. Supplementation of vitamin A was reported to result in increased maternal serum retinol concentrations and increased breast milk retinol concentration. It reduced the risk of anemia (Hb < 11 g/dL) and reduced maternal clinical infection. Vitamin D supplementation increased 25-hydroxy vitamin D levels. There was insufficient evidence for the effect on bone mineral density and serum calcium levels. Calcium supplementation did not have any significant effect on body weight, weight gain, and body mass index of the participants. Conclusion This overview of systematic reviews reiterates the nutritional importance of vitamin A, vitamin D, and calcium supplementation for the reproductive age women. However, there was no empirical evidence available for fortification of food with vitamin A, vitamin D, and calcium and nutritional benefits of the same for reproductive age women, therefore thrusting upon the need of conducting future quality research, i.e., clinical trials and systematic reviews for food fortification. Systematic review registration A priori protocol for this overview of systematic reviews was registered in PROSPERO with registration number CRD42018089403.

Objective: To explore the factors associated with social isolation among older people using the data from Building Knowledge Base on Population Ageing in India (BKPAI) survey. Methods: Multiple logistic regression and classification and regression tree (CART) analysis were used to identify the factors associated with social isolation using data from BKPAI survey. An individual was regarded as socially isolated if the response was “never” to all 4 activities in the last 12 months: (1) attending public meeting, (2) attending any group/club/organizational meeting, (3) attending any religious program, and (4) visiting friends or relatives. Results: Among 9836 older people, 19.7% were observed to be socially isolated. From multiple logistic regression, age (odds ratio [OR] = 1.85 for age 80 to 89 years and OR = 2.67 for age ≥90), religion (OR = 0.54 for Christians compared to Hindus), duration of stay in current home (OR = 0.64 for 6-10 years compared to >10 years of stay), number of activities of daily living (ADLs) for which the assistance was needed (OR = 2.09 for 1 or 2, OR = 3.14 for 3 or 4, and OR = 12.05 for 5 or 6), and Alzheimer's disease (OR = 1.65) were identified as factors associated with social isolation. Number of ADL for which the assistance was needed and self-reported health status were the factors identified through CART analysis. Discussion: Requiring help in performing ADL, advancing age, and Alzheimer's disease were the likely factors for socially isolation among elderly patients in this surveyed population.

Background Breast cancer is the most prevalent cancer among women worldwide and it is found to be increasing. Breast cancer survivors are threatened with various problems due to disease itself or its treatment and might exist for a long period even after treatment. The existing knowledge on experiences and needs among breast cancer survivors in India is very limited. The present study aimed to explore the experiences and needs of breast cancer survivors. Methods In the present study qualitative study design was used and 17 breast cancer survivors, post six months of completed cancer treatment were selected using purposive sampling technique. In-depth interviews were conducted, the data was transcribed and translated and codes and theme were developed. Results The study explored the needs and experiences of breast cancer survivors. The experiences of breast cancer survivors were as follows; awareness, psychological expressions, spirituality and misconceptions, economic burden, confinement, body image and bashfulness, maintaining secrecy, family support and physical burden. The needs of breast cancer survivors were identified as financial, informational, breast reconstruction surgery, help in household activities, family support, counseling and emotional support. Conclusion Recognizing the experiences and needs of the breast cancer survivors by the family members, health care workers, community members and policy makers after the end of treatment is important to facilitate optimal delivery of health care at the community settings to improve the quality of life of breast cancer survivors.

Objective The systematic review explores personal experiences and perceptions of (and on) resident Indian women on family planning. Methods We included qualitative studies conducted among women, husbands and mothers-in-law. Search on five databases (published between 2000 and May 8, 2019) and forward and backward citations search of included studies were undertaken (April 2020). Three-stage screening and data extraction were done independently. Iterative process was followed to thematically analyse the data and presented it using the World Health Organization conceptual framework on social determinants of health. Result Of 857 citations, we included 48 qualitative studies. Women's intent of using family planning services/methods was influenced by multiple factors such as socio-demographic characteristics. Women's agency and social status affected their standing in family planning decision-making. Fear of side-effects of contraception methods, access to information and support, and cultural and religious beliefs hindered the use of modern methods of contraceptive. Undesirable attitudes of service providers influenced underutilisation of family planning services. Ineffective contraceptive choice counselling, particularly for poor section of the community and high-risk groups were reported. While considering inter-pregnancy interval, some of the women opted for induced abortion to terminate unplanned pregnancy however, had meagre acceptance for using modern contraceptive methods. Conclusion The findings call for reinvigorated efforts to provide effective and individually, religiously, regionally and culturally appropriate interventions to improve family planning access and ultimately support better health and rights of women in India.

Supplemental Material, Supplementary_data_-_EBF for A mixed-methods systematic review on barriers to exclusive breastfeeding by Divya Sussana Patil, Prachi Pundir, Vijay Shree Dhyani, Jisha B. Krishnan, Shradha S Parsekar, Sherize Merlin D’Souza, N Ravishankar and Vishnu Renjith in Nutrition and Health

Additional file 5. Detailed synthesis of the data.

Additional file 1. PRISMA checklist.

Additional file 6. References of the primary studies. This file consists of the references for the primary studies or RCTs included in the systematic reviews that were used for data synthesis.

Additional file 4. R-AMSTAR table.

Additional file 2. Search Strategy.

Additional file 3. Characteristics of included studies.

BACKGROUND: Cancer care is physically and psychologically challenging both for care recipients and caregivers. Caregiving in cancer is an area that needs urgent attention in India. Much of caregiving literature in India is limited to mental illnesses. This study thus examines the perceptions and practices of psychological caregiving among caregivers and care recipients of breast cancer in India. METHODS: Participants were interviewed with the aid of a semi-structured qualitative interview guide. Participants included 39 caregivers and 35 care recipients in different breast cancer stages. Interviews were transcribed, translated to English, coded and themes were derived for further analysis. Informed consent from participants, and ethical clearance and permission from a tertiary hospital was obtained prior to data collection. RESULTS: Psychological caregiving as perceived by the participants included actions such as encouraging, convincing care recipients, companionship, and maintaining a stress free environment. Caregivers in particular felt that psychological caregiving meant, reacting calmly to sensitive queries of non-family members, providing emotional support to other family members and involvement in religious activities. Taking on such diverse responsibilities gave rise to several unmet psychological needs such as motivation and support in decision-making from other family members. CONCLUSION: Irrespective of the status (caregiver or care recipient), participants in this study felt the need for structured counselling services to be incorporated into the standard care protocol. This is an area that needs to be further explored in the context of the breast cancer caregiver and care recipient dyad. This article is protected by copyright. All rights reserved.

Background The caregiver burden for mental health is found all over the world and almost eight out of ten caregivers face it when providing care to the mentally ill person, as the illness is challenging and chronic in nature. Stigma due to mental health contributes to increase in the burden of caregivers. Methods A qualitative research methodology was adopted to understand the perception of caregivers of mentally ill patients. In-depth interview of 20 participants was conducted who were the caregivers of mentally ill patients in the hospital. Results From the perceptions of caregivers, we have derived four themes under which the perceptions of caregivers are described. Conclusion We can conclude that stigma towards mental health in the society is a burden for caregivers when taking care of mentally ill patients and it is obstructing overall mental and physical well-being of the patient.